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Hospital-acquired pneumonia in ICU

Marc Leone 1, 2 Lila Bouadma 3 Belaïd Bouhemad 4 Olivier Brissaud 5 Stephane Dauger 6 Sébastien Gibot 7 Sami Hraiech 8 Boris Jung 9, 10 Eric Kipnis 11 Yoann Launey 12 Charles-Edouard Luyt 13 Dimitri Margetis 14 Fabrice Michel 15 Djamel Mokart 16 Philippe Montravers 17 Antoine Monsel 18 Saad Nseir 11 Jérôme Pugin 19 Antoine Roquilly 20 Lionel Velly 15 Jean-Ralph Zahar 21, 22 Rémi Bruyère 23 Gérald Chanques 9
Abstract : The French Society of Anesthesia and Intensive Care Medicine and the French Society of Intensive Care edited guidelines focused on hospital-acquired pneumonia (HAP) in intensive care unit (ICU). The goal of 16 French-speaking experts was to produce a framework enabling an easier decision-making process for intensivists. The guidelines were related to 3 specific areas related to HAP (prevention, diagnosis and treatment) in 4 identified patient populations (COPD, neutropenia, postoperative and pediatric). The literature analysis and the formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research over the last 10 years was conducted based on publications indexed in PubMed™ and Cochrane™ databases. HAP should be prevented by a standardized multimodal approach and the use of selective digestive decontamination in units where multidrug-resistant bacteria prevalence was below 20%. Diagnosis relies on clinical assessment and microbiological findings. Monotherapy, in the absence of risk factors for multidrug-resistant bacteria, non-fermenting Gram negative bacilli and/or increased mortality (septic shock, organ failure), is strongly recommended. After microbiological documentation, it is recommended to reduce the spectrum and to prefer monotherapy for the antibiotic therapy of HAP, including for non-fermenting Gram-negative bacilli.
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Marc Leone, Lila Bouadma, Belaïd Bouhemad, Olivier Brissaud, Stephane Dauger, et al.. Hospital-acquired pneumonia in ICU. Anaesthesia Critical Care & Pain Medicine, Elsevier Masson, 2018, 37 (1), pp.83-98. ⟨10.1016/j.accpm.2017.11.006⟩. ⟨hal-01788072⟩

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